Toward an Understanding of the 'Medical Plantation' as a Cultural Location of DisabilityRachel DudleyEmory UniversityE-mail: radudle@emory.edu

Keywords:

This article uses Sharon Snyder and David Mitchell's concept of "cultural locations of disability" to theorize the 19th century medical plantation as a space in which black enslaved women were used as raw materials for medical-scientific advancement. The central argument is that the history can be perceived in new ways by applying the dual frameworks of black feminist theory and cultural disability theory to understand the medical plantation as a cultural location of disability. In so doing, the article demonstrates that on the 19th century medical plantation—a locality spatially separate from the agricultural plantation—black women's bodies were imagined as the ideal test subjects of research and innovation within what became modern gynecology.

"Mr. Wescott, Anarcha has an affection that unfits her for the duties required of a servant"

—Dr. James Marion Sims to an Alabama slave plantation owner, 1845

Introduction

For enslaved women on southern plantations vaginal fistulas were a liability that threatened plantation profits. Fistulas meant that women's reproductive capacity could no longer be used as a form of slave capital and that they were no longer available for sexual exploitation from slave-holders. The condition was most often the result of difficult and prolonged labor which compromised the lives of both mother and child. Scholars interested in health and slavery such as Deborah McGregor have explained the ways in which the demands put on enslaved women's productive and reproductive labor had an impact on the frequency of fistulas on the plantation: "the origins of the disorder were entangled in the system of slavery itself" (1998, 68). What this means is that the political economy of slavery produced distinct experiences of lost bodily integrity for enslaved women expected to reproduce and to be sexually available as a condition of their bondage.

This article references experimental procedures to correct vesico vaginal fistulas performed by James Marion Sims—known widely as "the father of modern gynecology"—on black female slaves in Alabama, between 1845 and 1849. Though various scholars with interests in the medical humanities have explored this history from various angles, the goal within this work is to begin animating a conversation between the fields of black feminist studies, cultural disability studies, and medical history by revisiting the origin narrative of modern gynecology. This approach is not about reaching back into history to claim these women as some sort of 'black crip' ancestral figures but rather to assert that such a dual framework is particularly suited to enliven new ways of perceiving and understanding this history.

I argue that examining the 'medical plantation' as a central feature of this history and as a cultural location of disability allows us to bring the aforementioned bodies of knowledge together productively with implications for continued exploration in the future. It also allows for a continuation of important cross-disciplinary work begun by scholars, activists and artists who attempt to destabilize hegemonic medical narratives and critique cultural artifacts which celebrate the great life of Sims and disappear the bodies/lives/realities of the numerous pained and enslaved women on whom he experimented (Kapsalis 1997; Kuppers 2007; McGregor; 1998 Wanzo 2009, Washington 2005). I assert that the space of the medical plantation was an integral feature in the use of black women's bodies to transform a condition representing an impediment on the slave plantation into a kind of medical entrepreneurship and a discrete branch of medicine.

In making this argument, I draw from performance studies scholar Petra Kuppers' concept of the "medical plantation" to refer to a locality spatially separate from the cotton, rice, coffee, sugar, wheat or tobacco plantation and specifically designated for medical practice on enslaved women as well as cultural disability studies scholars Sharon Snyder and David Mitchell's characterization of cultural locations of disability as current and historic sites that "[h]ave been set out exclusively for disabled citizen[s]" (2006, 3). This article also joins growing conversations in disability studies involving research related to critical race and disability studies as well as research related to slavery, health, illness, and disability from a humanities rather than a fully biomedical perspective. 1

The first section offers a brief background in order to orient the rest of the analysis. Next, the paper provides a broader historical context in relation to black women's healthcare and medical/scientific perceptions of black women's bodies in the nineteenth-century. The next section elaborates on what cultural locations of disability are and flushes out a theorization of the medical plantation as such a space. Here, I also highlight how the early history of gynecology has been taken up by other scholars doing work in the medical humanities and I discuss how understanding the medical plantation as a cultural location of disability extends their important work.

Who Was James Marion Sims? How do enslaved women figure into his medical career?

James Marion Sims had been practicing medicine for ten years before being summoned to the Wescott plantation near Montgomery, Alabama. He was called upon by another prominent physician to attend "To a case of labor which had lasted three days and the child not yet born" (Sims 1885, 226). It was June of 1845 and by this time Sims claims that he had established himself as a reputable surgeon and family physician who's first self-proclaimed "great discovery of medicine"—though slow to garner support in the burgeoning medical literature—involved treatment of trismus nascentium, also known as lock-jaw. His second "great discovery" would play a pivotal role in how he became a wealthy, well-known, and internationally-celebrated lecturer, an entrepreneurial medical showman, the founder of the Women's Hospital in New York, and one of the often acknowledged fathers of modern gynecology.

In his autobiography, The Story of My Life, Sims recalls that before leaving for the Wescott plantation he had been told by another physician, who had built a reputation working on functional derangement of the urinal system in women: "I am thinking that you had better take your instruments along with you, for you may want to use them" (226-7). When they arrived at the plantation Sims came upon Anarcha, a seventeen year-old slave who had been in labor for three days. Labor within the plantation economy was often prolonged because of lack of access to adequate nutrition and because the workload was not typically reduced for pregnant slaves. 2

Describing the situation Sims wrote: "[t]he child's head was so impacted in the pelvis that the labor pains had almost entirely ceased". He consulted with Dr. Henry, the other physician present, and concluded: "[t]he sooner she was delivered the better, and without any great effort the child was brought away with forceps" (227). Whether or not it was the use of forceps that led to what Sims called an extreme "sloughing of the soft parts" remains unknown.

Within five days, Anarcha became completely incontinent, both from her vagina and her rectum. Sims recalls, "I went home and investigated the literature of the subject thoroughly and fully. Then, seeing the master of the servant the next day, I said: 'Mr. Wescott, Anarcha has an affection that unfits her for the duties required of a servant" (227). The affection to which Sims refers is vesico-vaginal fistula—fissures within the vaginal walls or between the vagina and rectum—commonly resulting from traumatic child-birth or the insertion of foreign objects into the vagina. At the time, fistulas were considered incurable. 3

Sims' aforementioned comment to the plantation owner deserves some further scrutiny because it underscores why Anarcha underwent a shift from a being a forced participant in a plantation economy to an experimental subject of a medical economy. Black enslaved bodies were valued within the political economy of the time only to the extent that they were productive or useful—in the fields, in labor and reproduction, through sexual exploitation, in the house of the master, or as suggested here in medicine. The fistula meant that Anarcha's reproductive capacity could no longer be used as a form of slave capital and she was no longer available for sexual exploitation from slave-holders and perhaps that her ability to work would have been hampered.

What is known within the primary record about Anarcha comes to us only through plantation ledgers, medical journals and Sims' own autobiographical writing. It is known that she was not the only woman on whom Sims would experiment. He mentions two more women by first name—Lucy and Betsey, but he may have owned up to twelve whom were used in Sims' series of experiments over four years. Over time, many slave-holders brought their slaves who were experiencing vaginal/reproductive conditions to Sims and he also sought out slaves as well for his medical experiments (Sims 222-247). They were housed in what is being called here a medical plantation.

As Sims tells it, he purchased a spoon and invited two medical students to assist as he tested his new theory on Lucy: "Before I could get the bent spoon-handle into the vagina, the air rushed in with a puffing noise, dilating the vagina to its fullest extent. Sims felt he was viewing something "no man had seen before" because the act of looking into a woman's vagina represented a breach of nineteenth century Victorian social propriety. 4 However, enslaved women were excluded from notions of genteel femininity as expressed in representations of Sojourner Truth's "Ain't I A Woman Speech" delivered in 1851 at a women's convention in Akron, Ohio—canonical reading within Women's, Gender, and Sexuality Studies. 5 Hence, enslaved women were ideal experimental subjects for medical research especially research involving intimate privates and reproductive conditions.

Upon gazing into Lucy's vagina Sims claims he was certainly on the brink of a great discovery and he states, "I immediately went to work to invent instruments necessary for performing the operation on the principles that were self-evident on the first inspection of the first case" (235). This easy slippage in Sims' life narrative whereby he goes from directing the medical gaze into Lucy's vagina to seamlessly applying "self-evident principles" in the invention of the duck bill speculum certainly attests to his power in casting the narrative in a drastically heroic manner. Still, his speculum developed in 1846 would become a major technological innovation in modern gynecological practice. Ten years later, the American Journal of Medical Sciences published his procedures to suture vesico-vaginal fistulas using the duckbill speculum (Sims 1856).

It bears repeating that this medical innovation was founded on the bodies of black enslaved women with vaginal fistulas, which can and should be recognized as a kind of disability woven into the economy of slavery. It was the scientific and cultural view of the black body as being always already pathological that created the conditions for Sims to have uninhibited access to them as experimental subjects. Sims would alternate between the women, performing un-anesthetized surgeries on Anarcha over thirty times until he was finally able to develop and later publish a procedure to suture fistulas.

A Brief Overview: The Bodies of Black Women in the Nineteenth Century

There is a wealth of scholarship that historicizes and contextualizes the cultural attitudes and discourses surrounding black women's bodies within the nineteenth-century. 6 Aptly, health educator and performance studies scholar Terry Kapsalis notes that Sims' experimental subjects were triply pathologized and perceived as excessively symptomatic: "The first pathological symptom was their primary racial characteristic: their skin color. In a medical world that categorized life as either normal or pathological, people of the African diaspora were continually condemned to the category of pathological, their "abnormal" skin color serving as a foil for 'normal' white skin" (41). In fact, displays of "ethnic otherness" were central to the development of the modern freak show which allowed audiences to be educated and entertained by embodied differences from shifting ideological norms (Bogdan 1988, Garland-Thomson 1996).

These freak shows also displayed "pathological" black female sexuality; most notably Sara Baartman was displayed for a number of years throughout Europe as the Hottentot Venus, to demarcate differences between the "normal" European body form and the "pathological" African genitalia, buttocks and breasts (Crais and Scully 2010 and Gilman1985). She was posthumously dissected by the famous nineteenth-century scientist George Cuvier, her genitals and organs kept in jars for further study. Though Baartman was not an American slave, her story is part of the larger cultural construction of black female pathology which incorporated African American slave women. This brief overview of how black women's bodies were treated during the period helps us to understand why they were ideal subjects who became a part of the first act in Sims' career as a world-renowned medical showman.

Interestingly, Sims greatly admired the enormously successful entrepreneurial showman P.T. Barnum whom he mentions in his autobiography as a "good friend". In discussing the relationship between the two men, Terry Kapsalis asks, "[W]hat might link a surgeon-slave-master to a showman ringmaster? Both exercise mastery over bodies, particularly grotesque bodies (in the sense of either open, oozing bodies or freaks)" (33). The link between the two men is significant in highlighting how various cultural enterprises and medical fields were spun from the raw material of disabled bodies. While Barnum developed his mastery and appropriation of disabled bodies into a specialized form of entertainment, Sims developed his mastery of the fistula into a medical plantation which helped to create a discrete medical specialization. Though Kapsalis is not necessarily situated in disability studies, a disability studies framework allows for an understanding of the medical plantation created by Sims as a cultural location of disability created particularly for enslaved women.

Cultural Locations of Disability

[h]ave been set out exclusively for disabled citizens such as nineteenth-century charity systems; institutions for the feebleminded during the eugenics period; the international disability research industry, sheltered workshops for the "multiply handicapped "; medically based and documentary film representations of disability; and current academic research trends on disability (2006, 3).

Part of what Snyder and Mitchell reference is the development of disability identities through the creation of various specialized institutions in the nineteenth-century and this has been of keen interest to a number of contemporary cultural disability scholars and historians (Davis 2010; Longmore and Umansky 2001; Reiss 2008, Stiker 2000). These isolated spaces were usually designed through collaborations between government, medicine, and civil society to contain and manage disability. By the early twentieth-century charity systems, asylums, alms houses, rehabilitation centers and various other institutions had been developed to contain people considered insane, the blind, deaf, and/or 'multiply-handicapped'. These institutions were also designed to tend to people with an overall inability to work within a modern marketplace that required specific standards of bodily control and self-autonomy. Snyder and Mitchell demonstrate how the early locations actively disenfranchised people often deemed pathological and isolated them.

The creation of these cultural spaces was a part of the modernist project which entailed classification and management of various bodily variations as well as the development of statistics as a mechanism for capturing averages and creating standards of the normal body (Davis 2006). Often these institutions were built and maintained through seemingly benign discourses of sympathy, charity, benevolence and normalization. Snyder's and Mitchell's work is important because it examines the social and medical management of disability as a central aspect of the modernist project while focusing particularly on the connection between early cultural locations of disability and eugenic impulses.

Significantly, the authors leave room for additional analyses of cultural locations of disability beyond those explicitly theorized in their work, referring to the locations chosen for review they mention: "[t]hey are not the only locations that we might have selected for inclusion her[e]" (22). With this in mind, their work can be extended beyond an emphasis on institutional spaces of containment only for "disabled citizens". Recognizing that blacks were chattel slaves not entitled to any rights of citizenship, we can turn toward a cultural location intimately connected to enslaved black women's reproduction in bondage.

Sims' medical plantation was a space where black female 'pathology' and disability were transformed from abnormalities and impediments within the slave economy to economic activity and reproduction within the medical economy. Below, three core features of the medical plantation as a cultural location of disability are outlined so that we can continue to "theorize the space between embodiment and ideology" (Snyder and Mitchell 8).

First, the medical plantation was isolated and private thus removing the women from any community of other slave doctoring practices, healers, root doctors and/or midwives. Because Sims was not the first to discover or attempt to treat fistulas, it is at least worth imagining how the black slave community themselves might have responded to the condition. Republished in The Black Women's Health Book is a chapter from Mules and Men by Zora Neal Hurston entitled, "Prescriptions of Root Doctors" which lists various conditions and cures commonly used to treat them. One entry reads: "Fistula—sweet gum and mullen cooked down with lard. Make a salve" (1994, 15). Hurston was also an anthropologist whose writing may speak to the prevalence of vaginal fistulas on the plantation and to slave ingenuity in attempting to treat the condition before Sims would gain credit for finding a cure.

In Working Cures, a groundbreaking study that chronicles various aspects of slave approaches to healthcare, Sharla Fett explains: "[c]ommunities in slavery nurtured a rich health culture, a constellation of ideas and practices related to well-being, illness, health, and death, that worked to counter the onslaught of daily medical abuse and racist scientific theories" (2). Fett's central assertion is that slave communities participated in a relational idea of slave health based on relationships between individuals and broader communities that worked against notions of slave "soundness" held by slaveholders. Thus, the medical plantation is a symbolic space that represents the shift away from midwifery, root medicine, and folk knowledge toward a white male medical establishment as a feature of modernity. This is significant because the medical plantation also represents the kind of spatial distancing that always occurred for people being walled off within the early cultural locations of disability. Nineteenth century cultural locations of disability built on ideas about rehabilitation or restoration to 'normal' functioning involved isolation from larger communities and the application of specialized medical authority.

The medical plantation was a private space where ideas of the Cult of True Womanhood/ Victorian propriety—which never applied to black women—could be cast aside completely and modern medicine could literally gaze into black women's interiors to ascertain new medical knowledge from a newly invented medical position. Yet there has been a tendency to gloss over the particular bodies which became the pathways leading to new ways of knowing and "looking" at women's bodies in general in this medical history. In this sense the black female body though considered pathological, is also indispensible to medical knowledge production. Enslaved black women were, in terms of their bodily materiality, as much a part of the innovation of duckbill speculum as Sims—yet the bodies on which new knowledge was extracted and capitalized upon have few traces in the archives and in broader cultural memory.

The private space of the medical plantation that housed numerous enslaved women with fistulas for four years also represents a space of extreme cultural forgetting and extreme archival absences. This becomes yet another historical instance of black women being both centrally important to the advancement of medical science while at the same time remaining profoundly marginalized. The medical plantation is a cultural space where black women's nude bodies were literally hyper-exposed for medical advancement even while their lives and broader stories bear few traces at all; in effect they are both hyper-exposed in medicine and hyper-diminished in culture.

We can understand the medical plantation as a cultural location of disability that allowed for unmediated exposure to the bodies of black women with disabilities. As many other black feminist scholars have noted, black women's bodies have too often been simultaneously exposed and erased. Referencing black women's sexuality in particular, black feminist scholar Evelyn Hammonds suggests: "Black women's sexuality is often described in metaphors of speechlessness, space, or vision; as a void or empty space that is simultaneously ever visible (exposed) and invisible, where black women's bodies are always already colonized" (2004, 94). A later analysis at another time might interrogate the centrality of metaphors of ability in understanding cultural representations of black women's bodies. However, the point here is to draw a connection between black women's bodies as always already colonized and the kind of medical exploitation that echoes colonial narratives whereby the enslaved women's bodies and disabilities are unmapped geographies that Sims discovers and explores.

Sims' legacy and the ways in which he has been so widely remembered as an important world-renowned medical icon and highly public figure exists is in stark contrast to the diminishment and marginalization of the women whose bodies catapulted him into fame and fortune. So here we have the difference between two extremes, or put another way, the difference between the public and the private whereby the medical plantation is a private space representing extreme cultural amnesia while Sims is widely remembered and publicly celebrated through tropes of the great American man; his presence in public culture attests to him being someone important who lived a model life and is not to be forgotten. Various cultural artifacts including an oil painting, statues in different states, a medical instrument, a medical position and a hospital he co-founded all attest to the capaciousness of his legacy and the cultural urge to remember him. The medical plantation was an isolated and private space of containment that afforded Sims carte blanche to perform medical experimentation on medically and socially vulnerable enslaved black women with disabilities.

So now we come to the second feature of the medical plantation as a space that both symbolically and literally solidified a connection between medical/social vulnerability and medical exploitation. The medical plantation is a reminder, albeit one of the most extreme kind in history, of how social vulnerability and medical exploitation have often coalesced at the bodies of people of color and/or people with disabilities and severe illnesses. In fact the space of the medical plantation is a literal reminder of the ways in which gender, race and (dis)ability not only have historically co-constructed one another, but also have been placed at the center of the development of modern science and medicine (Baynton 2003; Kudlick 2003).

Two examples that should come immediately to mind in reference to the medical-scientific uses of black women and notions of pathological embodiment are the aforementioned story of Sara Baartman who was believed to represent the excesses of sexuality and also proof justifying taxonomies of racial difference; or the contemporary story of Henrietta Lacks whose cells were extracted unbeknownst to she and her family and later reproduced for the first time in history through cell cultures, then termed HeLa cells which are still used within multi-billion dollar medical-scientific industries for various kinds of research. 7

With Medical Apartheid, medical ethicist and journalist Harriet Washington provides a touchstone in the field of medical ethics; she offers a book length review of the exploitation of black bodies within medical research from colonial times to the present. Importantly, her work goes beyond the oft cited Tuskegee Syphilis study which was designed by U.S. Public Health Services to observe the effects of untreated syphilis in black men in Alabama from 1932-1972. Within her book, she demonstrates that while the black body has been used over and over again throughout history to further medical knowledge, black people have reaped few of the benefits of medical advancement due to vast medical disparities—or to use her stronger language—a deep seated medical apartheid.

Washington begins her review by explicitly mentioning Sims' experimentation on enslaved women in his early career to orient the rest of her book on medical exploitation. Yet her work is not necessarily situated in black feminist studies or cultural disability studies and as a result does not explicitly concern itself with the interaction between gender, race and ability within spaces of medical containment such as the medical plantation. The argument here is that the medical plantation can be considered a precursor to the later more systematic treatment of disability coinciding with eugenic impulses referred to by Snyder and Mitchell. Various cultural locations of disability such as mental asylums and institutions set aside for the so called feebleminded can be understood as spaces of medical containment where a cordoning off of the socially vulnerable from the rest of the body politic is a defining feature.

These spaces of containment are defined by removal of individuals from family and community where medical professionals were permitted unmediated access to treat and/or attempt to rehabilitate various disabilities. They are cultural sites where isolation, vulnerability, and medical exploitation intersect under the rubric of social welfare and benevolence. In fact it may very well be the case that Sims believed he was offering benevolent medical care, yet the underlying assumption involved in the creation of a medical space explicitly designed for vaginal surgery was a belief in a supernatural ability of blacks to bear pain.

The third feature of the medical plantation as a cultural location of disability is that it represented a physical space where theories of blacks having higher pain tolerance could be worked out and put to test. As women's studies and cultural studies scholar Rebecca Wanzo explains "[f]or Sims, blackness defined what pain meant for these women, just as white womanhood defined his understanding of white women's pain experience" (2009, 159). In a chapter entitled, "In the Shadows of Anarcha" which appears in her larger book project on sentimental political storytelling practices, Wanzo is interested in the ways in which official medical narratives, past and present, obscure the pain experiences of black women; this occurs in part because of broader cultural narratives regarding the "strong black woman" believed to possess an extraordinary ability to bear pain.

Wanzo helps us to understand the unspoken assumptions operating within the history of modern gynecology. She highlights for us "the ways in which the pain experience is not only physical and psychological but also political" (158). The reason enslaved black women were the ideal test subjects for four years of un-anesthetized vaginal surgery is directly connected to nineteenth century racial taxonomies and widely-published medical beliefs in racial differences. These differences were assumed to occur along the lines of ageing, intelligence, body type, sexuality, mental illness, and thresholds for pain tolerance.

Further, Wanzo gives attention to how sentimental political storytelling practices can create counter narratives to the stories that appear in the official archives regarding the pained black body. One such example referenced directly by Wanzo is the Anarcha Project, a staged performance that utilizes interpretive dance, personal stories and historical accounts to challenge hegemonic medical narratives. The Anarcha Project employs artistic strategies of resistance in order to reconsider the repetitive narrative of modern gynecology's origin story, to continue interrogating the relationships between race, gender, ability and bio-medical innovation; in short it helps us begin to imagine what alternative memorializing practices can be.

While Wanzo's work interrogates the tacit assumptions operating within the medical plantation, she does not theorize the medical plantation itself as a feature of the history of modern gynecology because she approaches this history from a different angle. What is being suggested here is that to understand the medical plantation as a cultural location of disability is to understand a space where ideology made contact with the human body. In this sense, the medical plantation was not only an experimental facility where Sims attempted to correct fistulas but it was also a walled off testing center used to employ theories of the 'super-ability' of black women to withstand repeated and deliberate bodily trauma. It is one thing to hold the belief in such a hyper-ability, it is another thing to put this belief into practice repeatedly for years on end while being faced with the corporeal reality of excruciating pain. It becomes necessary, then, to place these experiments within a wider context of slave health care and the relationship between pain and medical professionalism in the nineteenth century.

A Broader History of Slavery and Healthcare

A general understanding of the intersections of slavery and medical practice is necessary in order to situate Sims within a broader medical profession and to understand the context in which his medical plantation was created. In part we can turn toward nineteenth-century medical historian Todd Savitt in order to contextualize the stories of Anarcha, Lucy, and Betsey within the broader history of slavery and medicine. Through a bio-medical analysis, Savitt explains that plantation working conditions often led to the ill health of slaves. In turn, the poor health of slaves: "led to medical intervention that often became a contest between white medicine and the medical beliefs and practices of the slave community" (Savitt 2005, 14). There exists an interesting conflict between the acquisition of information about enslaved bodies to justify inferiority and the acquisition of enslaved bodies for experimentation to improve white masculanized medical knowledge. The power differentials and the vast differences in epistemological reference systems between black root doctors and medical physicians prevented any the sharing of knowledge that may have allowed for an enhanced and blended modern medical practice. 8

Slave ingenuity in medicine was important because slavery was an institution that required a kind of hyper-ablebodiedness even while the working conditions, lack of adequate nutrition, corporeal punishment, cramped slave quarters, extreme heat exposure, and forced breeding undermined such a requirement at every turn. Though slave masters often believed that slaves were feigning illness in order to escape the demands of slavery, it was obvious that sometimes medical intervention was necessary—Savitt explains:

Physicians who treated the enslaved had both pecuniary and professional concerns in black health. A physician's practice sometimes depended on a contract made with a slaveholder to provide medical services for his "family" (including his slaves), although most doctors charged by the visit. Moreover, the physical differences between whites and blacks that physicians observed and commented on became an important part of the rationale for slavery (14).

The above quote points out that the medical plantation was integral to the development of narratives of black difference and pathology particularly along the lines of the bodily experience of pain. Due to extreme distrust of white slave owners' intentions and white medical practice, slaves often received care through self-treatment, fellow herb doctors, and family remedies.

In this way, black healthcare can be framed as a form of resistance to growing white medical practice: "The dilemma was whether to treat illness at home, risking white reprisal, or submit to white medical practice and thus surrender their bodies to their owners. The result was a dual system in which some slaves received treatment from both whites and blacks. To complicate matters further, physicians answered to the slave owner so the enslaved patient might have no voice in his or her own treatment" (Savitt16). Honing in on Savitt's remarks here raises questions about the treatment from other African-Americans that may have been received by Anarcha, Lucy, Betsey and other slaves involved with Sims. Did they ever receive such treatment? Might it have been sweet gum and mullen cooked down with lard as suggested by Zora Neal Hurston? Were midwives treating these women before they were hailed into the position of medical plantation subjects? Did the women seek alternative forms of medicine from within their enslaved communities who had established networks of care to tend to illness and disability?

Savitt's work and the previously mentioned work by Deborah McGregor seem to suggest that they may have done so, yet these facts remain unknown with certainty. What is known with certainty is that the political economy of slavery offered Sims the ideal subjects on which to experiment and to weave a medical specialization from the raw materials of disability. Again, this was particularly so because black susceptibility to pain was often considered different than that of whites and this was used as a kind of justification for slavery. 9

Sims' autobiography includes comments about his subject's extraordinary tolerance for pain. For example, in discussing his first surgeries on Lucy he says: "that was before the days of anesthetics, and the poor girl, on her knees, bore the operation with great heroism and bravery" (236). Though Sims did not use anesthesia in his experimentation with the women, he did use morphine over a four year period and thus future research will need to probe deeper into the role of addiction within this history. Below, I situate Sims' experimentation within the context of pain and medical professionalism in the nineteenth century.

Nineteenth-century Pain and Medical Professionalism

Medical historian Martin Pernick has discussed the professional calculus involved in mid nineteenth-century surgical decision-making (1985). Just a half-century before this period, physicians followed a professional value of prolonging life over treating pain: "It is hard for us today to recreate the surgeon's feelings before anesthesia became available. The emotional ability to inflict vast suffering was perhaps the most basic of all professional prerequisites" (Pernick 27). It can be argued, as I argue here, that the ability to inflict suffering for physicians working with slaves was amplified by discourses surrounding black bodies as having a special capacity for bearing pain. Further, we cannot know, relying only on Pernick what the ethics of medical professionalism involved when patients were also slaves housed within a facility for their usage in surgical practice.

Significant cultural factors contributed to a new sensitivity to pain in the nineteenth century, including sentimental literature and humanitarian reform movements. 10 According to Pernick, a shift in cultural sensitivity to suffering and the development of new interventions in pain treatments: "Combined to alter profoundly the professional values of nineteenth-century doctors" (26). One of these new interventions was anesthesia, which began to be used medically in 1846. The development of anesthesia for use in medical practice corresponds roughly to the timing of Sims' experiments from 1845-1849.

In Pernick's language, new mathematical models for evaluating the costs and benefits of such medical drugs can be thought of as a "calculus of suffering". In the nineteenth century, physicians began to weigh the pros and cons of pain relief during surgery. This professional shift did not happen seamlessly. In fact, the medical field was extremely fractured around the safety of anesthesia as an intervention in pain (30). Medical practitioners who followed the new approach to pain were influenced by, "[a] utilitarian philosophy, a social moderation, and a numerical frame of mind, none of which were prominent in American medicine prior to 1830" (33). By the time Sims opened the Women's Hospital in New York, anesthesia was more widely and commonly used during surgery. Yet in Sims' early career, beliefs in the exceptional ability of blacks to bear pain were naturalized and contributed to the use of slave women for isolated research performed over four years on his medical plantation.

It is necessary to note that slavery scholar Saidiya Hartman cautions against the often casual discussion of terror, pain and scenes of black suffering (1997). Within Hartman's analysis, the discussion begins with the passage in Frederick Douglass's slave narrative where he describes the brutality of watching his aunt being lashed. Speaking of such oft-repeated scenes of subjection in slavery:

What interests me are the ways we are the ways we are called upon to participate in such scenes. Are we witnesses who confirm the truth of what happened in the face of the world-destroying capacities of pain, the distortions of torture, the sheer unrepresentability of terror, and the repression of the dominant accounts? Or are we voyeurs fascinated with and repelled by exhibitions of terror and sufferance? What does the exposure of the violated body yield? (3)

Of course, caution is necessary to avoid a slippage between re-remembering a painful history and promoting the pornography and fetishism of pain. Yet actively remembering the violated bodies of black enslaved women in this medical context can lead to a more nuanced and necessary understanding of the medical plantation as a cultural location of disability as a space where ideology and medical practice converge.

Given that pain—due to illness, disability, psychic trauma, addiction to morphine, or repeated vaginal surgery—played no small role within Sims' medical plantation, we should spend more time grappling with the important questions of pain and bodily integrity the case presents particularly in the field of disability studies. The questions raised by the case, as has been suggested throughout this paper, are varied and multiple but revolve broadly around issues of race, gender, space, medical vulnerability and ethics. Black women's particular pathologized bodies were used as the generalized and generative bodies of western gynecological knowledge. The site in which the new knowledge was extracted was a cultural location of disability referred to here as the medical plantation. What is remembered about this location and what is forgotten has everything to do with which epistemological frameworks we use to interrogate it.

Conclusion

This paper has demonstrated that black women's bodies were imagined as the ideal test subjects of research and innovation within what became modern gynecology. The paper has also provided relevant historical contextualization of cultural and medical discourses regarding the black body and black women's bodies in particular. Scholars who have examined the role of enslaved women within Sims' medical career have helped to bring the stories involving Anarcha, Lucy, and Betsey into the forefront of the larger history of gynecology's development as a discrete medical specialization. Yet a scholarly analysis, based within the humanities, that specifically uses black feminist theory and feminist disability theory to animate alternative understandings of Sims' medical plantation has yet to be written. This paper has been written as a part of a larger dissertation proposal to move toward such a black feminist/feminist disability studies mode of medical history analysis.